McMurray’s test is a commonly used test in orthopaedic examination to test for tears of the meniscus. The McMurray’s test is a rotational maneuver of the knee that is frequently used in the examination of the patient to help in the diagnosis of meniscal tears. Meniscus injuries are very common. When the patient sustains an injury of the knee and has a meniscal tear, usually the patient complains of knee pain localized to the medial or lateral side of the knee. The patient may also have locking and clicking. Sometimes the patient will have an effusion and sometimes this effusion is small (swelling of the knee). Joint line tenderness is the most sensitive finding. Joint line tenderness can be on the medial side (medial meniscal tear) or on the lateral side (lateral meniscal tear). There will be minimal swelling of the knee and possible extension lag (locked knee) due to a displaced bucket handle tear of the meniscus. Pain at a higher level than the joint is usually associated with medial collateral ligament tear. If an MCL tear is present, it is usually avulsed from the medial femoral condyle. The MCL is rarely avulsed from the tibia. Pain at a lower level is usually associated with the pes anserine bursitis. McMurray’s test is a knee examination test that shows pain or a painful click as the knee is brought from flexion to extension with either internal or external rotation of the knee. The McMurray’s test uses the tibia to trap the meniscus between the femoral condyles of the femur and the tibia. When performing the McMurray’s test, the patient should be lying supine with the knee hyperflexed. The examiner then grasps the patient’s heel with one hand and places the other hand over the knee joint. To test the medial meniscus, the knee is fully flexed, and the examiner then passively externally rotates the tibia and places a valgus force. The knee is then extended in order to test the medial meniscus. To test the lateral meniscus, the examiner passively internally rotates the tibia and places a varus force. The knee is then extended in order to test the lateral meniscus. A positive test is indicated by pain, clicking or popping within the knee joint and may signal a tear of either the medial or lateral meniscus when the knee is brought from flexion to extension. There are mixed reviews for the validity of this test. There are other clinical tests that are as good as the McMurray’s test, however MRI is making the diagnosis of a meniscal tear easier. MRI is very sensitive, and it also excludes other associated injuries. I find that the McMurray’s test is valuable in getting insurance approval for performing an MRI. If you state that the McMurray’s test is positive, then the insurance will approve the MRI. Nowadays though, the McMurray’s test does not give us a lot of valuable clinical information, because we get the information from other tests.
